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A little more than a week after the horrific shooting in Aurora, Colo., we’re beginning to get some impression of James Holmes, the man who allegedly carried out the attack, and much of it is pointing to signs of mental illness. His appearance in court alone suggested that he might be dazed, delirious or heavily medicated. Secondly, the degree to which he had meticulously planned the attack suggests an obsession with violence, although we still don’t know if this stems from pure hatred or delusional impulse. His life appears to have been unraveling in the months prior to the assault when he withdrew from his graduate program. And his defense attorney has confirmed that he’d been seeing a psychiatrist.

We don’t know why he was seeing the psychiatrist, but these details suggest someone in a state of serious mental decline. Holmes did not suddenly snap in a single moment. His months of preparation point to a seething desire to cause harm to others. Something had broken in him, creating a most unnatural desire to hurt those who had done him no wrong.

Ironically, this level of premeditation also likely means that his defense team will have a hard time arguing that he’s legally insane. Although standards vary from state to state, generally the bar for legal insanity is very high and requires that the perpetrator was unaware of the wrongfulness of their actions. A person who believes their neighbor is a space alien coming to suck out their brain and attacks him, an action believed to be self-defense, could qualify as insane, for instance. But Holmes’ crime wasn’t impulsive. It came out of long-term planning, so it will be harder to make the case that he didn’t know what he was doing was wrong.

But mental illness, in fact, is quite common among mass-homicide perpetrators. According to the U.S. Secret Service report on school shooters, 78% had a history of suicide attempts or suicidal thoughts. Sixty-one percent had a history of serious depression. And a full 98% perceived themselves as having experienced a recent major loss. Others had full psychotic breaks, with delusions driving them toward paranoia and violence.

During an interview following the Aurora shooting, a reporter asked me what was different about mass homicides compared with other violent crimes. Unlike most violence in society, which has been precipitously declining for two decades, mass homicides appear to have remained steady. Although their incidence has not, in fact, been increasing, neither are they declining like most violent acts, as my colleague criminologist James Fox has noted.

It is difficult to pinpoint any one thing in society that may be responsible for this. Mass homicides don’t track well with the economy, social conflict, media-violence rates or much of anything else. But as Grant Duwe notes in his book on the history of mass homicides, although they occur throughout history, their rise began in the late 1960s and coincided with the deinstitutionalization movement, when mental asylums were closed down and services diminished. It is difficult to attribute causality between two events in history. Yet it is worth considering that although as a society we have gotten more peaceful as a whole, we have done little to either protect ourselves from or to help a tiny fraction of individuals who are both most in need of help and potentially of great danger to the rest of us.